MedWorm: Aortic Stenosis

Alcohol septal ablation after transaortic valve implantation: The dynamic nature of left outflow tract obstruction

Catheterization and Cardiovascular Interventions — Mon, 06 Feb 2012 05:00:00 +0100

This report highlights the dynamic nature of LVOT obstruction, which was successfully treated in our patient with catheter‐based alcohol septal ablation. The potential to unmask dynamic LVOT obstruction with TAVI should be an important consideration in patient selection for the procedure, and the postoperative assessment of these patients. © 2011 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)

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Cost-effectiveness of transcatheter aortic valve replacement in patients ineligible for conventional aortic valve replacement

Heart — Mon, 06 Feb 2012 05:00:00 +0100

Conclusions TAVI is highly likely to be a cost-effective treatment for patients with severe aortic stenosis who are currently ineligible for SAVR. (Source: Heart)

A risk score for predicting mortality in patients with asymptomatic mild to moderate aortic stenosis

Heart — Mon, 06 Feb 2012 05:00:00 +0100

Conclusion A new seven factor model for risk stratification of patients with mild to moderate asymptomatic AS identified a high risk group for total mortality with good discrimination properties. Trial registration number ClinicalTrials.gov, NCT 00092677. (Source: Heart)

Sex-Related Differences in Clinical Presentation and Outcome of Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis

Journal of the American College of Cardiology — Thu, 02 Feb 2012 13:55:34 +0100

Conclusions: Female sex is associated with better baseline clinical characteristics and improved survival, and is identified as a predictor of midterm survival after TAVI. (Source: Journal of the American College of Cardiology)

The original family revisited after 37 years: odontoma–dysphagia syndrome is most likely caused by a microduplication of chromosome 11q13.3, including the FGF3 and FGF4 genes

Clinical Oral Investigations — Thu, 02 Feb 2012 06:56:37 +0100

Conclusion The microduplication identified in this family represents the most likely cause of the odontoma–dysphagia syndrome and implies that the syndrome is caused by a gain of function of the FGF3 and FGF4 genes. Clinical relevance Mutations of FGF receptor genes can cause craniofacial syndromes such as odontoma–dysphagia syndrome. Following this train of thought, an evaluation of FGF gene family in sporadic odontoma could be worthwhile. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s00784-012-0676-6Authors Thomas Ziebart, Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg-University of Mainz, Augustusplatz 2, 55131 Mainz, GermanyFlorian G. Draenert, Department of O...

Minimally invasive surgery for aortic stenosis in the geriatric patient: where are we now?

Future Medicine: Aging Health — Wed, 01 Feb 2012 14:53:41 +0100

Aging Health , February 2012, Vol. 8, No. 1, Pages 17-30. (Source: Future Medicine: Aging Health)

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Cardiac O-GlcNAc signaling is increased in hypertrophy and heart failure

Physiological Genomics — Wed, 01 Feb 2012 05:00:00 +0100

Reversible protein O-GlcNAc modification has emerged as an essential intracellular signaling system in several tissues, including cardiovascular pathophysiology related to diabetes and acute ischemic stress. We tested the hypothesis that cardiac O-GlcNAc signaling is altered in chronic cardiac hypertrophy and failure of different etiologies. Global protein O-GlcNAcylation and the main enzymes regulating O-GlcNAc, O-GlcNAc transferase (OGT), O-GlcNAcase (OGA), and glutamine-fructose-6-phosphate amidotransferase (GFAT) were measured by immunoblot and/or real-time RT-PCR analyses of left ventricular tissue from aortic stenosis (AS) patients and rat models of hypertension, myocardial infarction (MI), and aortic banding (AB), with and without failure. We show here that global O-GlcNAcylation wa...

Survival and predictive factors of mortality after 30 days in patients treated with percutaneous implantation of the CoreValve aortic prosthesis

American Heart Journal — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: Transcatheter aortic valve implantation with the CoreValve prosthesis for patients with aortic stenosis and a high surgical risk is a safe, efficient option resulting in a medium-term clinical improvement. Survival during follow-up depends on the associated comorbidities. Early mortality beyond 30 days is predicted by preoperative comorbidity scores and the functional status of the patient. (Source: American Heart Journal)

Transcatheter Aortic Valve-in-Valve-in-Valve Implantation for a Failed Xenograft.

The Annals of Thoracic Surgery — Tue, 31 Jan 2012 04:18:52 +0100

Authors: Bagur R, Dumont E, Doyle D, De Larochellière R, Rodés-Cabau J Abstract A 78-year-old gentleman with a diagnosis of symptomatic severe xenograft aortic stenosis with multiple comorbidities was referred for transcatheter aortic valve implantation, that is, a "valve-in-valve" procedure. Transcatheter aortic valve implantation was performed by transapical approach using a balloon-expandable bioprosthesis. During valve deployment, the prosthesis moved toward the left ventricle and a second balloon-expandable valve was implanted within the first one-a "valve-in-valve-in-valve" to avoid further ventricular embolization of the first bioprosthesis. Echocardiography at hospital discharge showed a residual mean transvalvular gradient of 17 mm Hg and trivial paravalvular aortic regu...

Three-dimensional printing of models for preoperative planning and simulation of transcatheter valve replacement.

The Annals of Thoracic Surgery — Tue, 31 Jan 2012 04:13:14 +0100

In this study, we show the use of three-dimensional printing models for preoperative planning of transcatheter valve replacement in a patient with an extreme porcelain aorta. A 70-year-old man with severe aortic stenosis and a porcelain aorta was referred to our center for transcatheter aortic valve replacement. Unfortunately, the patient died after the procedure because of a potential ischemic event. Therefore, we decided to fabricate three-dimensional models to evaluate the potential effects of these constructs for previous surgical planning and simulation of the transcatheter valve replacement. PMID: 22269765 [PubMed - in process] (Source: The Annals of Thoracic Surgery)

Women Do Better After TAVI, Hints Small Study Women Do Better After TAVI, Hints Small Study

Medscape Today Headlines — Mon, 30 Jan 2012 22:42:23 +0100

The first foray into possible gender differences in presentation and outcome among patients undergoing TAVI for severe aortic stenosis hints that women may fare better than men after this procedure. Heartwire (Source: Medscape Today Headlines)

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Women do better after TAVI, hints small study

theHeart.org — Mon, 30 Jan 2012 21:00:00 +0100

Patient-specific simulations of transcatheter aortic valve stent implantation

Medical and Biological Engineering and Computing — Sun, 29 Jan 2012 06:36:48 +0100

In this study, patient-specific analyses were performed to explore the feasibility of TAVI in morphologies, which are currently borderline cases for a percutaneous approach. Five patients were recruited: four patients with failed bioprosthetic aortic valves (stenosis) and one patient with an incompetent, native aortic valve. Three-dimensional models of the implantation sites were reconstructed from computed tomography images. Within these realistic geometries, TAVI with an Edwards Sapien stent was simulated using finite element (FE) modelling. Engineering and clinical outcomes were assessed. In all patients, FE analysis proved that TAVI was morphologically feasible. After the implantation, stress distribution showed no risks of immediate device failure and geometric orifice areas inc...

CAD and Aortic Stenosis in the TAVR Era: Old Questions, New Paradigms. The Evolving Role of PCI in the Treatment of Patients with Aortic Stenosis.

Circulation — Thu, 26 Jan 2012 05:00:00 +0100

Authors: Kodali SK, Moses JW Abstract Significant coronary artery disease (CAD) is present in up to 50% of patients with symptomatic aortic stenosis (AS). The standard treatment has been coronary artery bypass grafting at the time of surgical aortic valve replacement (AVR). While numerous databases have shown that the addition of bypass grafting to an AVR nearly doubles the mortality, surgical series have shown that leaving significant coronary stenosis untreated increases AVR mortality(1-4). Thus the standard of care for this population has been concomitant coronary artery bypass grafting along with surgical aortic valve replacement. (SELECT FULL TEXT TO CONTINUE). PMID: 22282328 [PubMed - as supplied by publisher] (Source: Circulation)

Percutaneous Coronary Intervention in Patients with Severe Aortic Stenosis: Implications for Transcatheter Aortic Valve Replacement.

Circulation — Thu, 26 Jan 2012 05:00:00 +0100

CONCLUSIONS: PCI can be performed in patients with severe symptomatic AS and CAD without an increased risk of short term mortality compared to propensity matched patients without AS. Patients with EF ≤30% and STS score ≥10% are at a highest risk of 30-day mortality after PCI. This finding has significant implications in the management of severe CAD in high risk severe symptomatic AS patients being considered for TAVR. PMID: 22282327 [PubMed - as supplied by publisher] (Source: Circulation)

Three-Dimensional Printing of Models for Preoperative Planning and Simulation of Transcatheter Valve Replacement [CASE REPORTS]

The Annals of Thoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

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Transcatheter Aortic Valve-in-Valve-in-Valve Implantation for a Failed Xenograft [CASE REPORTS]

The Annals of Thoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

A 78-year-old gentleman with a diagnosis of symptomatic severe xenograft aortic stenosis with multiple comorbidities was referred for transcatheter aortic valve implantation, that is, a "valve-in-valve" procedure. Transcatheter aortic valve implantation was performed by transapical approach using a balloon-expandable bioprosthesis. During valve deployment, the prosthesis moved toward the left ventricle and a second balloon-expandable valve was implanted within the first one—a "valve-in-valve-in-valve" to avoid further ventricular embolization of the first bioprosthesis. Echocardiography at hospital discharge showed a residual mean transvalvular gradient of 17 mm Hg and trivial paravalvular aortic regurgitation. At 1 year follow-up, the patient was in New York Heart Association functi...

Myocardial metabolism and diastolic function after aortic valve replacement for aortic stenosis: influence of patient-prosthesis mismatch [ADULT CARDIAC]

European Journal of Cardio-Thoracic Surgery — Wed, 18 Jan 2012 05:00:00 +0100

CONCLUSION Aortic valve replacement leads to early improvement of left ventricle function and myocardial metabolism in all patients regardless of the occurrence of patient—prosthesis mismatch. (Source: European Journal of Cardio-Thoracic Surgery)

Clinical predictors of prosthesis-patient mismatch after aortic valve replacement for aortic stenosis

Clinics — Wed, 18 Jan 2012 00:35:44 +0100

OBJECTIVE: We sought to ascertain predictors of Patient Prosthesis Mismatch, an independent predictor of mortality, in patients with aortic stenosis using bioprosthetic valves. METHOD: We analyzed 2,107 sequential surgeries. Patient Prosthesis Mismatch was calculated using the effective orifice area of the prosthesis divided by the patient's body surface area. We defined nonsignificant, moderate, and severe Patient Prosthesis Mismatch as effective orifice area indexes of .0.85 cm²/m, 0.85-0.66 cm²/m², and

TAVI good value for patients with severe aortic stenosis

PharmacoEconomics and Outcomes News — Sun, 15 Jan 2012 04:11:42 +0100

(Source: PharmacoEconomics and Outcomes News)

The Natural History of Moderate Aortic Stenosis in a Veteran Population

Journal of Surgical Research — Sat, 14 Jan 2012 22:28:53 +0100

(Source: Journal of Surgical Research)

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Foreword

Current Problems in Cardiology — Fri, 13 Jan 2012 14:04:36 +0100

Catheter-based interventional therapy for valvular heart disease arrived on the scene in the last 10 years. During this time, the field has progressed remarkably rapidly particularly for treatment of aortic stenosis. For mitral regurgitation (MR), many techniques have been tried mostly in experimental animals and several have been attempted in humans. (Source: Current Problems in Cardiology)

Clinical Outcome in Asymptomatic Severe Aortic Stenosis: Insights From the New Proposed Aortic Stenosis Grading Classification

Journal of the American College of Cardiology — Fri, 13 Jan 2012 13:52:06 +0100

Conclusions: The use of the new proposed AS grading classification integrating valve area and flow-gradient patterns allows a better characterization of the clinical outcome of patients with asymptomatic severe AS. (Source: Journal of the American College of Cardiology)

Varying Hemodynamics and Differences in Prognosis in Patients With Asymptomatic Severe Aortic Stenosis and Preserved Ejection Fraction: A Call to Review Cutoffs and Concepts⁎

Journal of the American College of Cardiology — Fri, 13 Jan 2012 13:52:06 +0100

Management of patients with asymptomatic severe aortic stenosis (AS) and preserved ejection fraction (EF) continues to puzzle cardiologists. The open questions begin with the very definition of the lesion. American guidelines require a valve area 40 mm Hg (), but on the basis of the landmark report of Otto et al. (), a peak velocity >4 m/s is also regarded as a marker of severe stenosis. However, mean gradients are usually approximately one-half of peak gradients in aortic stenosis, and thus a 4-m/s peak gradient predicts a peak gradient of 64 mm Hg, which typically will correspond to a mean gradient lower than 40 mm Hg, the cutoff for severe AS cited in the preceding text. The European guidelines, in turn, use an even higher >50-mm Hg cutoff for mean gradient in severe AS (). Thus the cut...

Homozygous Familial Hypercholesterolemia: Case Series and Review of the Literature

Computational Intelligence and Neuroscience — Thu, 12 Jan 2012 11:11:41 +0100

Conclusion. OLT is a safe and effective option for patients with homozygous FH refractory to maximal medical therapy and may represent the optimal treatment for these patients. (Source: Computational Intelligence and Neuroscience)

Aortic Stenosis Grading System Misses Rare, High-Risk GroupAortic Stenosis Grading System Misses Rare, High-Risk Group

Medscape Today Headlines — Mon, 09 Jan 2012 23:17:53 +0100

A new study has examined the clinical outcomes of asymptomatic aortic stenosis patients classified by valve area plus flow-gradient patterns instead of the older inherently inconsistent system based on separate area, gradient, and flow measurements. Heartwire (Source: Medscape Today Headlines)

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Aortic stenosis grading system misses rare, high-risk group

theHeart.org — Mon, 09 Jan 2012 22:00:00 +0100

A new study has examined the clinical outcomes of asymptomatic aortic-stenosis patients classified by valve area plus flow-gradient patterns instead of the older, inherently inconsistent system based on separate area, gradient, and flow measurements. (Source: theHeart.org)

Risk Not Equal in Cases of Severe Aortic Stenosis (CME/CE)

MedPage Today State Required CME — Mon, 09 Jan 2012 20:00:00 +0100

(MedPage Today) -- Among patients classified broadly as having asymptomatic severe aortic stenosis, it appears that assessing transvalvular flow rates and pressure gradients can help further stratify risk, researchers found. (Source: MedPage Today State Required CME)

Copy number variation in Williams-Beuren syndrome: suitable diagnostic strategy for developing countries

BMC Research Notes — Mon, 09 Jan 2012 05:00:00 +0100

Conclusion: MLPA was considered a faster and more economical method in a single assay, whereas the microsatellite markers could determine both the size and parental origin of the deletion in WBS. The microsatellite marker and MLPA techniques are effective in deletion detection in WBS, and both methods provide a useful diagnostic strategy mainly for developing countries. (Source: BMC Research Notes)

Long-term follow-up of reduction ascending aortoplasty with autologous partial wrapping: for which patient is waistcoat aortoplasty best suited?

Interactive CardioVascular and Thoracic Surgery — Mon, 09 Jan 2012 05:00:00 +0100

Conclusions Waistcoat aortoplasty proved a safe and durable treatment for patients with asymmetric non-syndromic non-familial ascending aorta dilatation. The technique showed its best durability in aortic stenosis patients and in patients with normofunctional BAV. (Source: Interactive CardioVascular and Thoracic Surgery)

Groundbreaking TAVR Procedure A First For Kentucky

Health News from Medical News Today — Thu, 05 Jan 2012 08:00:00 +0100

Some individuals with severe aortic stenosis - also known as narrowing of the aortic valve in the heart - who are not well enough to undergo open heart surgery have a new treatment option thanks to a groundbreaking procedure now available in Kentucky from UofL physicians at Jewish Hospital. A team that included University of Louisville cardiologists Michael Flaherty, M.D, Ph.D., Naresh Solankhi, M.D., and UofL cardiothoracic surgeon Matthew Williams, M.D., performed the first transcatheter aortic-valve replacement (TAVR) procedure on a 47-year-old male patient on Dec. 21, 2011... (Source: Health News from Medical News Today)

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The Axillary/Subclavian Artery Access Route for Transcatheter Aortic Valve Replacement: A Systematic Review of the Literature.

The Annals of Thoracic Surgery — Thu, 05 Jan 2012 05:00:00 +0100

Authors: Caceres M, Braud R, Roselli EE Abstract A primary predictor for success with catheter-based treatment of structural heart disease is having safe remote access to the heart. The devices for transcatheter aortic valve replacement require large-bore access, but many patients with severe aortic stenosis also have iliofemoral disease or relative contraindications to transapical access. In such situations, the leading alternative vascular access site has been the axillary or subclavian artery. This approach has been used with increasing frequency, and as these new devices become more readily available, it is anticipated that the experience will grow. Literature on the use of this access site for transcatheter aortic valve replacement is reviewed to highlight the current understa...

Deformation Dynamics and Mechanical Properties of the Aortic Annulus by 4-Dimensional Computed Tomography: Insights Into the Functional Anatomy of the Aortic Valve Complex and Implications for Transcatheter Aortic Valve Therapy

Journal of the American College of Cardiology — Wed, 04 Jan 2012 18:27:39 +0100

Conclusions: The aortic annulus, generally elliptic, assumes a more round shape in systole, thus increasing CSA without substantial change in perimeter. Perimeter changes are negligible in patients with calcified valves, because tissue properties allow very little expansion. Aortic annulus perimeter appears therefore ideally suited for accurate sizing in transcatheter aortic valve implantation. (Source: Journal of the American College of Cardiology)

Optimizing Transcatheter Aortic Valve Sizing and Minimizing Vascular Complications⁎

Journal of the American College of Cardiology — Wed, 04 Jan 2012 18:27:39 +0100

Percutaneous aortic valve replacement (PAVR) is an exceptionally innovative procedure that will undoubtedly alter the way we treat patients with severe aortic stenosis. A procedure once reliant on the operative visual information and feedback afforded to the cardiovascular surgeon is now supplanted by a multitude of imaging technologies available to the interventional cardiologist. Already since the advent of this technology, interventionists have become more cognizant of the intricate anatomopathological relationships of the aortic valve complex. Unfortunately to date, no single imaging modality provides all of the necessary anatomical and functional information needed for safe and effective transcatheter valve implantation. It is now more imperative for us to be aware of the many differe...

An Option for the High-Comorbidity Patient With Mitral Regurgitation⁎

Journal of the American College of Cardiology — Wed, 04 Jan 2012 18:27:39 +0100

The past 2 years have seen the culmination of a number of important pivotal trials in percutaneous structural heart disease intervention, including PARTNER A and B (Placement of AoRTic TraNscathetER Valve Trial), EVEREST II (Endovascular Valve Edge-in-Edge REpair STudy), CLOSURE I, and PROTECT AF (Embolic Protection of Patients in Atrial Fibrillation Trial), all attempting to provide a high-level evidence base for selected patients with aortic stenosis, mitral regurgitation (MR), patent foramen ovale, and atrial fibrillation, respectively. In general, these studies have yielded more nuanced results than their predecessor registries and have dampened some of the enthusiasm within the cardiology community for their major innovations. The outcomes did not produce undisputed winners. The EVERE...

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2011

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 04 Jan 2012 16:41:50 +0100

There have been rapid advances in oral anticoagulation. The oral factor Xa inhibitors rivaroxaban and apixaban and the oral direct thrombin inhibitor dabigatran recently have been rigorously evaluated. These novel anticoagulants will usher in a new paradigm for perioperative anticoagulation. Perioperative blood conservation in cardiac surgery recently has been highlighted in the updated guidelines by the Society of Cardiovascular Anesthesiologists and the Society of Thoracic Surgeons. These recommendations reflect a comprehensive evaluation of the recent evidence to optimize transfusion practice. Transcatheter mitral valve repair continues to mature. Transcatheter aortic valve implantation for aortic stenosis has entered the clinical mainstream, with randomized trials showing its superiori...

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UofL physicians, Jewish Hospital first in Kentucky to offer new aortic valve replacement

EurekAlert! - Medicine and Health — Tue, 03 Jan 2012 05:00:00 +0100

(University of Louisville) Some individuals with severe aortic stenosis -- also known as narrowing of the aortic valve in the heart -- who are not well enough to undergo open heart surgery have a new treatment option thanks to a new procedure now available in Kentucky from University of Louisville physicians at Jewish Hospital. (Source: EurekAlert! - Medicine and Health)

Decreased pre-surgical CD34+/CD144+ cell number in patients undergoing coronary artery bypass grafting compared to coronary artery disease-free valvular patients.

Atherosclerosis — Tue, 03 Jan 2012 05:00:00 +0100

CONCLUSIONS: Pre-surgical CD34+/CD144+ numbers are decreased in CABG patients, compared to valvular patients with absence of coronary disease. PMID: 22214418 [PubMed - as supplied by publisher] (Source: Atherosclerosis)

Attenuating effect of post-treatment with QiShenYiQi Pills on myocardial fibrosis in rat cardiac hypertrophy.

Clinical Hemorheology and Microcirculation — Tue, 03 Jan 2012 05:00:00 +0100

Authors: Li YC, Liu YY, Hu BH, Chang X, Fan JY, Sun K, Wei XH, Pan CS, Huang P, Chen YY, Wang CS, Zheng J, Han JY Abstract QiShenYiQi Pills® (QSYQ) is a compound Chinese medicine used for treatment of cardiovascular diseases. However, the potential of QSYQ to inhibit cardiac fibrosis in left ventricle hypertrophy is not explored to date. We investigated the effects of post-treatment QSYQ on rat myocardial fibrosis in left ventricle hypertrophy induced by pressure over-load through ascending aortic stenosis. QSYQ was administrated 4 weeks after the surgery, at a dose of 0.8 g/kg/day over the next 4 weeks, while echocardiography was performed 4 and 8 weeks, respectively, after the surgery. Eight weeks after the surgery, myocardial blood flow was determined by Laser-Doppler Perfusion...

Transcatheter implantation of an aortic valve prosthesis in a female patient with severe bicuspid aortic stenosis

European Heart Journal — Sun, 01 Jan 2012 05:00:00 +0100

(Source: European Heart Journal)

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Three‐Dimensional Echocardiography in Valvular Heart Disease

Echocardiography — Sun, 01 Jan 2012 05:00:00 +0100

Two‐dimensional echocardiography (2DE) with color Doppler has been the standard tool for assessing valvular heart disease. However, this requires conceptualizing three‐dimensional (3D) valvular anatomy from individual 2D slices, which is inadequate for complex valvular abnormalities. Similarly, Doppler‐based methods are inherently limited by several assumptions and are influenced by hemodynamics and concomitant valvular disease. 3DE has improved both morphological and functional assessment of valvular heart disease. It provides additional morphological information, which leads to better understanding of the mechanism of valvular dysfunction and surgical planning. 3D planimetry has proven to be accurate in the evaluation of valvular stenosis. This direct assessment eliminates measurem...

Anaesthetic management of transcatheter aortic valve implantation.

Annals of Cardiac Anaesthesia — Sun, 01 Jan 2012 05:00:00 +0100

Authors: Franco A, Gerli C, Ruggeri L, Monaco F Abstract Transcatheter aortic valve implantation (TAVI) is an emergent technique for high-risk patients with aortic stenosis. TAVI poses significant challenges about its management because of the procedure itself and the population who undergo the implantation. Two devices are currently available and marketed in Europe and several other technologies are being developed. The retrograde transfemoral approach is the most popular procedure; nevertheless, it may not be feasible in patients with signiﬁcant aortic or ileo-femoral arterial disease. Alternatives include a transaxillary approach, transapical approach, open surgical access to the retroperitoneal iliac artery and the ascending aorta. A complementary approach using both devices ...

Impact of Left Ventricular Afterload on Longitudinal Dyssynchrony in Patients With Severe Aortic Stenosis and Preserved Ejection Fraction.

Circulation Journal — Wed, 28 Dec 2011 05:00:00 +0100

Conclusions: Significant longitudinal dyssynchrony was present in patients with severe AS and preserved EF, and it improved after AVR. PMID: 22214899 [PubMed - as supplied by publisher] (Source: Circulation Journal)

Modifiers of Elastin Insufficiency [Molecular Bases of Disease]

Journal of Biological Chemistry — Fri, 23 Dec 2011 05:00:00 +0100

Elastin haploinsufficiency causes the cardiovascular complications associated with Williams-Beuren syndrome and isolated supravalvular aortic stenosis. Significant variability exists in the vascular pathology in these individuals. Using the Eln+/− mouse, we sought to identify the source of this variability. Following outcrossing of C57Bl/6J Eln+/−, two backgrounds were identified whose cardiovascular parameters deviated significantly from the parental strain. F1 progeny of the C57Bl/6J; Eln+/−x129X1/SvJ were more hypertensive and their arteries less compliant. In contrast, Eln+/− animals crossed to DBA/2J were protected from the pathologic changes associated with elastin insufficiency. Among the crosses, aortic elastin and collagen content did not correlate with quantitative vascul...

Preoperative investigations in adult cardiac surgery patients

Surgery (Medicine Publishing) — Fri, 23 Dec 2011 00:08:11 +0100

Abstract: Preoperative investigations in cardiac surgery can be divided into diagnostic studies and assessment of fitness for surgery. Diagnostic investigations are used to detect and evaluate coronary, valvular, myocardial and thoracic aortic disease. Knowledge of an individual patient’s co-morbidities helps to determine the risk of postoperative morbidity and mortality, and allows for more accurate informed consent. Furthermore, the results of preoperative investigations may predict the likely postoperative support required in order to maximize the chances of uneventful recovery. New innovations such as transcatheter aortic valve implantation (TAVI) procedure are increasingly being used as alternatives to open heart surgery for very high-risk patients with severe aortic stenosis. This ...

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Oxidative‐mechanical stress signals stem cell niche mediated Lrp5 osteogenesis in eNOS‐/‐ null mice

Journal of Cellular Biochemistry — Thu, 22 Dec 2011 05:00:00 +0100

ConclusionTargeting the Wnt3a/Lrp5 pathway in valve calcification and activation of osteogenesis is via an oxidative‐mechanical stress in CAVD. These findings provide a foundation for treating this disease process by targeting the cross talk mechanism in a resident stem cell niche. J. Cell. Biochem. © 2011 Wiley Periodicals, Inc. (Source: Journal of Cellular Biochemistry)

Aortic Valve Replacement in the Elderly: The Real Life [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Wed, 21 Dec 2011 05:00:00 +0100

Conclusions Today, valve replacement has acceptable low hospital mortality, even in the elderly. Thus, older patients should not be denied surgery due to their advanced age alone. Conventional surgery remains the gold standard treatment for aortic stenosis; the decision should be made on an individual basis. If several risk factors suggest very high-risk surgery, then percutaneous valve implantation should be considered instead. (Source: The Annals of Thoracic Surgery)

Automated Coring and Apical Connector Insertion Device for Aortic Valve Bypass Surgery [NEW TECHNOLOGY]

The Annals of Thoracic Surgery — Wed, 21 Dec 2011 05:00:00 +0100

Conclusions The automated coring and apical connector insertion device facilitated the safe and effective performance of aortic valve bypass surgery. (Source: The Annals of Thoracic Surgery)

How to Remove the CoreValve Aortic Bioprosthesis in a Case of Surgical Aortic Valve Replacement [HOW TO DO IT]

The Annals of Thoracic Surgery — Wed, 21 Dec 2011 05:00:00 +0100

Transcatheter aortic valve implantation has been introduced as a treatment modality applied to high-risk surgery patients with severe symptomatic aortic stenosis, and it has been demonstrated to be an efficient and safe treatment option. Litzler and colleagues reported a case of a bailout of a transcatheter aortic valve implantation because of severe paravalvular leaks, using a 23-mm Edwards-SAPIEN Valve (Edwards Lifesciences, Irvine, CA), with conversion to conventional surgical aortic valve replacement. The authors reported an easy valve removal despite the impaction of the stent in the cusps of the native valve. Thyregod and colleagues reported a surgical valve replacement in a patient with a dysfunctional CoreValve self-expanding aortic valve bioprosthesis 4 months after implantation. ...

Influence of Myocardial Fibrosis on Left Ventricular Hypertrophy in Patients with Symptomatic Severe Aortic Stenosis

Cardiology — Mon, 19 Dec 2011 23:00:00 +0100

Cardiology 2011;120:139–145 (DOI:10.1159/000334792) (Source: Cardiology)

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Extracorporeal membrane oxygenation with hemoconcentration in a hypervolemic patient with critical aortic stenosis.

Texas Heart Institute Journal — Mon, 19 Dec 2011 09:30:03 +0100

Authors: Gregoric ID, Kar B, Gholkar G, Patel S, Crane T, Nathan S, Loyalka P Abstract Herein, we describe the case of a 60-year-old man with severe nonischemic cardiomyopathy and hypervolemia. By means of venoarterial extracorporeal membrane oxygenation at the bedside, along with hemoconcentration, the patient was resuscitated from severe cardiogenic shock and normal blood volume was restored. Within 24 hours, he was able to undergo a high-risk aortic valve replacement for severe aortic stenosis, with a successful outcome. To our knowledge, this is the first reported case in which hemoconcentration with extracorporeal membrane oxygenation has been used to support a patient with severe hypervolemia. PMID: 22163137 [PubMed - in process] (Source: Texas Heart Institute Journal)

MDCT to Guide Transcatheter Aortic Valve Replacement and Mitral Valve Repair

Cardiology Clinics — Thu, 15 Dec 2011 05:00:00 +0100

Percutaneous management of valvular heart disease is becoming a reality, with multicenter trials supporting minimally invasive procedures for both aortic and mitral valve disease. Historically, the treatment of choice has been aortic valve replacement with conventional surgery for patients with severe aortic stenosis, as the prognosis of untreated patients is poor, particularly if the patient is symptomatic. Transcatheter aortic valve replacement is now available as a minimally invasive option to treat select high-risk patients with severe aortic stenosis. At present more than 30,000 procedures have been performed worldwide, mostly confined to patients at high surgical risk. The short- and medium-term outcomes have been promising. (Source: Cardiology Clinics)

Heart Disease Treatments May Be Possible With New Scanning Strategy

Health News from Medical News Today — Wed, 14 Dec 2011 08:00:00 +0100

Patients with life-threatening heart valve disease could be helped with alternative scanning techniques that provide greater insight into the condition. Researchers from the University of Edinburgh used an imaging technique that could help predict which patients will need open heart surgery to replace their heart valves, and improve treatments to prevent the disease. The narrowing and hardening of the heart's aortic valve - a common condition known as aortic stenosis - affects 1 in 20 people over 65 in the UK and is on the increase due to an ageing population... (Source: Health News from Medical News Today)

Patients with aortic stenosis referred for TAVI: treatment decision, in-hospital outcome and determinants of survival.

Netherlands Heart Journal — Wed, 14 Dec 2011 05:00:00 +0100

CONCLUSIONS: Approximately two-thirds of the patients referred for TAVI receive this treatment with gratifying short- and long-term survival. Another 7% underwent AVR. Prognosis is poor in patients who do not receive valve replacement therapy. PMID: 22167520 [PubMed - as supplied by publisher] (Source: Netherlands Heart Journal)

PET can benefit aortic stenosis patients

AuntMinnie.com Headlines — Tue, 13 Dec 2011 19:29:30 +0100

Scottish researchers are using PET imaging to analyze heart valves and discover (more) (Source: AuntMinnie.com Headlines)

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Aortic stenosis

BHF National News — Mon, 12 Dec 2011 12:00:00 +0100

New BHF research sheds light on common condition (Source: BHF National News)

Unusual Doppler trace in mitral stenosis: prominent isovolumic relaxation flow

Heart — Mon, 12 Dec 2011 05:00:00 +0100

We describe the case of a 35-year-old woman who presented with combined mitral and aortic stenosis, and a peculiar and unusual finding on Doppler evaluation. A 2D echocardiogram revealed rheumatic mitral stenosis of moderate severity with a mitral valve area of 1.2 cm2 and coexisting severe aortic stenosis with a peak systolic gradient of 68 mm Hg and mean systolic gradient of 42 mm Hg, with a calculated aortic valve area of 0.8 cm2. Continuous wave Doppler interrogation of the mitral inflow revealed an interesting pattern of flow during the isovolumic relaxation (IVR) phase of diastole, leading to a peculiar ‘triphasic’ mitral inflow trace (figure 1). Pulsed wave Doppler interrogation confirmed it to be prominent intraventricular apically directed...

EUROECHO: Valve Fix Value Unclear in Certain Aortic Stenosis (CME/CE)

MedPage Today Cardiovascular — Sun, 11 Dec 2011 04:00:00 +0100

BUDAPEST (MedPage Today) -- Patients with severe aortic stenosis with low flow and low pressure gradient shouldn't automatically be excluded from valve replacement or repair, researchers suggested, though the group as a whole doesn't benefit from surgery. (Source: MedPage Today Cardiovascular)

EUROECHO: Left Ventricle Mass Increases With Insulin Resistance (CME/CE)

MedPage Today Cardiovascular — Fri, 09 Dec 2011 16:15:00 +0100

BUDAPEST (MedPage Today) -- Insulin resistance may accelerate left ventricular hypertrophy in aortic stenosis, and statins appear to worsen the problem, researchers found. (Source: MedPage Today Cardiovascular)

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Measurement of Effective Aortic Valve Area Using Three‐Dimensional Echocardiography in Children Undergoing Aortic Balloon Valvuloplasty for Aortic Stenosis

Echocardiography — Fri, 09 Dec 2011 05:00:00 +0100

Conclusion: 3DE facilitates EOA measurement in pediatric AS and correlates with change in aortic valve gradient after balloon valvuloplasty. (Echocardiography ****;**:1–8) (Source: Echocardiography)

Apico-aortic Conduit for Aortic Stenosis in a Patient with Chronic Thoracic Wall Infection.

Annals of Thoracic and Cardiovascular Surgery — Fri, 09 Dec 2011 05:00:00 +0100

We report a case of an apico-aortic bioprothesis-valved conduit for a 70-year-old-woman with symptomatic, severe aortic stenosis and severe calcification of the ascending aorta. She had a history of mastectomy and radiation therapy for breast cancer and was suffering from radiodermatitis and chronic thoracic wall infection. Transthoracic echocardiography showed severe aortic valve stenosis with heavy calcification and high aortic valve pressure gradients. In patients with a chronically infected thoracic wall, median sternotomy is considered to be a high risk procedure, resulting in postoperative mediastiniti; therefore, we applied a technique in which we used an apico-aortic conduit via posterolateral thoracotomy. We underwent apico-aortic bypass with a hand-made composite graft: 19-mm bio...

Aortic Valve Replacement to a Patient with High Titer of Cold Agglutinin.

Annals of Thoracic and Cardiovascular Surgery — Fri, 09 Dec 2011 05:00:00 +0100

Authors: Kansaku R, Kuwaki K, Amano A, Inaba H, Tambara K, Yamamoto T, Sakakibara N Abstract A 60-year-old man was admitted to our hospital because of aortic stenosis with a peak pressure gradient of 61 mmHg, moderate aortic regurgitation, and a dilatation of the ascending aorta of 50 mm in diameter, which had grown 5 mm in 2 years. Because of severe aortic stenosis with a bicuspid valve and fast progression of the ascending aorta in size, replacements of both the aortic valve and the ascending aorta were planned.He had experienced severe acute renal failure with hemolysis because of cold agglutinin one year before the operation. The hemoglobin had decreased to 4.3 g/dL during hemolytic attack. His titer of cold agglutinin was extremely high. The titer of cold agglutinin has kept a...

Inside human aortic stenosis: A proteomic analysis of plasma.

Journal of Proteomics — Thu, 08 Dec 2011 05:00:00 +0100

Authors: Gil-Dones F, Darde VM, Orgaz SA, Lopez-Almodovar LF, Mourino-Alvarez L, Padial LR, Vivanco F, Barderas MG Abstract Valvular aortic stenosis (AS) produces a slowly progressive obstruction in left ventricular outflow track. For this reason, aortic valve replacement is warranted when the valvular stenosis is hemodinamically significant, becoming the most common worldwide cause of aortic valve surgery. Recent epidemiologic studies have revealed an association between degenerative AS and cardiovascular risk factors for atherosclerosis, althought reducing the exposure to such factors and statin therapies both fail to delay or reverse the pathology. Hence, a deeper understanding of the pathophysiology of this disease is required to identify appropriate preventive measures. A prot...

Left‐ventricular outflow tract ventricular‐tachycardia event following corevalve transcatheter aortic‐valve implantation

Catheterization and Cardiovascular Interventions — Wed, 07 Dec 2011 05:00:00 +0100

We describe a patient with severe aortic stenosis who underwent CoreValve (Medtronic) implantation and presented several days later with a tachyarrhythmic episode. The electrocardiographic features of the arrhythmia were compatible with left‐ventricular outflow tract ventricular‐tachycardia. The life‐threatening event was not associated with ischemia or an electrolyte disorder and was not drug‐induced. A probable cause was the irritation of the myocardium by the prosthetic valve. Clinicians should be aware that the presence of anatomical parameters that increases the risk for myocardial injury and the need for pacemaker implantation might indicate an increased risk of a tachyarrhythmic episode. © 2011 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Intervention...

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Diffusion-weighted MRI determined cerebral embolic infarction following transcatheter aortic valve implantation: assessment of predictive risk factors and the relationship to subsequent health status

Heart — Fri, 02 Dec 2011 05:00:00 +0100

Conclusion Multiple small cerebral infarcts occurred in 77% of patients with TAVI. The majority of infarcts were ‘silent’ with clinical stroke being associated with a both higher infarct number and volume. Increased age and the severity of aortic arch atheroma were independent risk factors for the development of new cerebral infarcts. Overall HRQoL improved and there was no association between the number of new cerebral infarcts and altered health status. (Source: Heart)

Successful Use of the TandemHeart Percutaneous Ventricular Assist Device as a Bridge to Recovery for Acute Cellular Rejection in a Cardiac Transplant Patient

Transplantation Proceedings — Thu, 01 Dec 2011 05:00:00 +0100

In this report, we presented a patient who benefited from hemodynamic support with the TandemHeart Percutaneous Ventricular Assist Device (pVAD; Cardiac Assist, Inc) implantation in the setting of early acute graft rejection 2 months after orthotopic heart transplant. The TandemHeart initially had been used for temporary hemodynamic assistance during postcardiotomy heart failure and high-risk coronary interventions. More recently, its use in patients with cardiogenic shock from acute myocardial infarction, fulminant myocarditis, and critical aortic stenosis has been reported. To our knowledge, this is one of the first reported cases in which the TandemHeart pVAD served as a successful device for support during acute cardiac transplant rejection. (Source: Transplantation Proceedings)

Mid-Term Outcomes After Aortic Valve Replacement With the 17-mm St. Jude Medical Regent Valve.

Circulation Journal — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions: The 17-mm Regent prosthesis provided satisfactory clinical and hemodynamic results. It is a reliable choice for patients with a small aortic annulus. PMID: 22130314 [PubMed - as supplied by publisher] (Source: Circulation Journal)

Alteration in Subendocardial and Subepicardial Myocardial Strain in Patients with Aortic Valve Stenosis: An Early Marker of Left Ventricular Dysfunction?

Journal of the American Society of Echocardiography — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions: Bilayer ratio can reliably differentiate patients with varying degrees of AS severity and is a sensitive marker of LV function. These findings suggest that the evaluation of subendocardial and subepicardial radial strain might be a novel method for assessing LV mechanics in patients with AS. (Source: Journal of the American Society of Echocardiography)

Amplatzer septal occluder to treat iatrogenic cardiac perforations

Catheterization and Cardiovascular Interventions — Wed, 30 Nov 2011 05:00:00 +0100

Conclusions: Percutaneous device occlusion of iatrogenic heart perforation seems to be a safe and efficient method to treat iatrogenic heart perforation. In order to perform this elegant method, it is however imperative not to prematurely withdraw the perforating catheter to maintain access to the hole for closure. © 2011 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)

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Clinical outcome following transcatheter aortic valve implantation in patients with impaired left ventricular systolic function

Catheterization and Cardiovascular Interventions — Fri, 25 Nov 2011 05:00:00 +0100

Conclusion:The immediate and long‐term outcome after TAVI did not differ between patients with an impaired and preserved LVEF. LVEF ≤ 35% did not predict adverse immediate and long‐term outcome. These findings suggest that TAVI should not be withheld in selected patients with impaired LV function. © 2011 Wiley‐Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)

Outcomes of Surgical Aortic Valve Replacement in Octogenarians

Heart, Lung and Circulation — Fri, 25 Nov 2011 02:38:01 +0100

Background: In the current surgical era there have emerged new challenges in the management of aortic stenosis (AS) in elderly patients. Given the ageing population and the increasing prevalence of aortic stenosis amongst elderly patients, aortic stenosis represents a high and increasing burden to public health . With the advent of transcatheter aortic valve implantation (TAVI) as a minimally invasive alternative for potentially high-risk patients requiring AVR, the outcomes for this particular cohort are emerging as a focus of interest . In this context, what constitutes high surgical risk has undergone a definitional revision, with new impetus to more accurately define those patients who would benefit most from TAVI . The changing nature of patient demographics and available treatment mo...

Trans-apical Aortic Valve Replacement: The Flinders Experience

Heart, Lung and Circulation — Fri, 25 Nov 2011 02:38:01 +0100

We report our outcomes to date. (Source: Heart, Lung and Circulation)

Ambivalent effect of aortic stenosis on von Willebrand factor and thrombin generation. Is transvalvular gradient the guilty party?

Heart — Thu, 24 Nov 2011 05:00:00 +0100

Aortic valve sclerosis-stenosis is the most common valvular pathology in industrialised countries, evolving from aortic valve sclerosis into aortic stenosis (AS). Aortic valve sclerosis is present in 25% and AS in 2% of people aged >65 years. Heyde syndrome is an acquired and intricate pathology encountered in AS and in the obstructive form of hypertrophic cardiomyopathy (HOCM).1–3 In its initial description Heyde syndrome is a syndrome of AS associated with gastrointestinal (GI) bleeding of idiopathic origin, which was subsequently linked to angiodysplasia. Angiodysplasia is predominantly observed in the elderly and is characterised by small vascular dilatations of GI submucosal veins and capillaries, ultimately leading to arteriovenous communications. This vascular malforma...

Increased thrombin generation and platelet activation are associated with deficiency in high molecular weight multimers of von Willebrand factor in patients with moderate-to-severe aortic stenosis

Heart — Thu, 24 Nov 2011 05:00:00 +0100

Conclusion Patients with advanced AS deficient in vWF HMWM are characterised by enhanced thrombin formation and platelet activation. This observation indicates the ambivalent impact of high shear stress in AS on haemostasis and might help explain two aspects of AS—Heyde syndrome and increased risk of thromboembolism. (Source: Heart)

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Clinical outcomes in non-surgically managed patients with very severe versus severe aortic stenosis

Heart — Thu, 24 Nov 2011 05:00:00 +0100

Conclusions Surgery should always be considered in very severe AS regardless of symptoms, and particular attention needs to be paid to their extremely poor outcomes. (Source: Heart)

Early Doppler-echocardiography evaluation of Carpentier-Edwards Standard and Carpentier-Edwards Magna aortic prosthetic valve: comparison of hemodynamic performance.

Cardiovascular Ultrasound — Thu, 24 Nov 2011 05:00:00 +0100

Conclusions: Our data confirm the good hemodynamic performance of both aortic bioprostheses and the more favourable hemodynamic profile of CEPM compared to CEPS, pointing out the need to perform routinely an accurate baseline Doppler-echocardiography evaluation early after surgery to allow an adequate interpretation of data at follow-up. (Source: Cardiovascular Ultrasound)

Load-induced changes in ventricular repolarization: evidence of autonomic modulation.

Canadian Journal of Physiology and Pharmacology — Thu, 24 Nov 2011 05:00:00 +0100

Authors: Sedova KA, Goshka SL, Vityazev VA, Shmakov DN, Azarov JE Abstract Augmented hemodynamic load increases the risk of arrhythmogenesis by modulating cardiac repolarization duration. We hypothesized that the intervention on the autonomic tone may affect the load-dependent changes in ventricular repolarization. Activation-recovery intervals were measured in unipolar electrograms simultaneously recorded from 64 ventricular epicardial leads, in a total of 26 chinchilla rabbits in resting conditions, and after 1 and 10 min of aortic stenosis. Eleven animals were given atropine and propranolol before the loading. The short-term stenosis decreased the activation-recovery intervals in the right ventricle, whereas the prolonged overload increased the repolarization duration in both v...

Perioperative and long-term outcomes following aortic valve replacement: a population cohort study of 4124 consecutive patients [Original articles]

European Journal of Cardio-Thoracic Surgery — Wed, 23 Nov 2011 05:00:00 +0100

Conclusions: Patients undergoing aortic valve replacement have a poor risk profile. Over time, their numbers, age and co-morbidity have increased. In spite of these, there has been a significant reduction in the risk of perioperative death. (Source: European Journal of Cardio-Thoracic Surgery)

The Progression of a Transcatheter Aortic Valve Program: A Decision Analysis of More Than 680 Patient Referrals [ORIGINAL ARTICLES: ADULT CARDIAC]

The Annals of Thoracic Surgery — Wed, 23 Nov 2011 05:00:00 +0100

Conclusions With the availability of a novel treatment option for aortic stenosis in high-risk patients, institutions offering these alternative methods will be forced to reevaluate patient management. A careful strategy that includes multidisciplinary evaluation is crucial in order to have a successful transcatheter aortic valve program. (Source: The Annals of Thoracic Surgery)

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A Growing Problem: Maternal Death and Peripartum Complications Are Higher in Women With Grown-Up Congenital Heart Disease [ORIGINAL ARTICLES: PEDIATRIC CARDIAC]

The Annals of Thoracic Surgery — Wed, 23 Nov 2011 05:00:00 +0100

Conclusions The GUCH parturients, especially those with VSD, have increased risk of mortality and peripartum complications compared with other age-matched women. Despite these risks, nearly 50% of GUCH patients deliver at nonteaching hospitals. Current national practice patterns for GUCH women are inadequate, and outcomes could be improved by education and proper triage of even relatively "simple" GUCH lesions such as atrial septal defect and VSD. Further studies that investigate risk-adjusted outcomes in a variety of care settings are necessary to resolve this complex issue. (Source: The Annals of Thoracic Surgery)

Successful Transcatheter Aortic Valve Implantation Through Ascending Aorta and Total Revascularization Using Edwards SAPIEN Transcatheter Heart Valve System [CASE REPORTS]

The Annals of Thoracic Surgery — Wed, 23 Nov 2011 05:00:00 +0100

We describe a successful case of valve implantation via the transaortic route with simultaneous full revascularization. (Source: The Annals of Thoracic Surgery)

Procedure- and Age-Specific Risk Stratification of Single Aortic Valve Replacement in Elderly Patients Based on Japan Adult Cardiovascular Surgery Database.

Circulation Journal — Wed, 23 Nov 2011 05:00:00 +0100

Conclusions: sAVR has produced good surgical results in Japan. Procedure- and age-specific analyses have identified a risk profile that is unique to sAVR patients in the elderly population in Japan. PMID: 22112860 [PubMed - as supplied by publisher] (Source: Circulation Journal)

Transcatheter Valve-in-Valve Implantation Using CoreValve Revalving System for Failed Surgical Aortic Bioprostheses

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 21 Nov 2011 05:00:00 +0100

Conclusions CRS implantation was feasible and effective regardless of the prevalent mode of failure. This finding may significantly affect the treatment of patients with a failed bioprosthesis deemed at a prohibitive risk for surgical redo. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Value of Electrocardiogram in the Differentiation of Hypertensive Heart Disease, Hypertrophic Cardiomyopathy, Aortic Stenosis, Amyloidosis, and Fabry Disease

The American Journal of Cardiology — Mon, 21 Nov 2011 05:00:00 +0100

Left ventricular hypertrophy is 1 of the most frequent cardiac manifestations associated with an unfavorable prognosis. However, many different causes of left ventricular hypertrophy exist. The aim of the present study was to assess the diagnostic value of common electrocardiographic (ECG) parameters to differentiate Fabry disease (FD), amyloidosis, and nonobstructive hypertrophic cardiomyopathy (HC) from hypertensive heart disease (HHD) and aortic stenosis (AS). In 94 patients with newly diagnosed FD (n = 17), HHD (n = 20), amyloidosis (n = 17), AS (n = 20), and HC (n = 20), common ECG parameters were analyzed and tested for their diagnostic value. A stepwise approach including the Sokolow–Lyon index, corrected QT duration, and PQ interval minus P-wave duration in lead II to overcome P-...

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[Percutaneous coronary intervention and aortic valve implantation in a patient with breast cancer.]

Kardiologia Polska — Sat, 19 Nov 2011 21:24:02 +0100

We present a case of a 70 year-old female with severe aortic stenosis, multivessel coronary artery disease and breast cancer who successfully underwent complex percutaneous coronary revascularisation, transapical aortic valve implantation and mastectomy. Kardiol Pol 2011; 69, 11: 1165-1167. PMID: 22090229 [PubMed - as supplied by publisher] (Source: Kardiologia Polska)

Transcatheter aortic valve implantation: results of the current development and implantation of a new Brazilian prosthesis

Revista Brasileira de Cirurgia Cardiovascular — Fri, 18 Nov 2011 11:23:26 +0100

CONCLUSION: The transapical implantation of catheter mounted bioprosthesis is a safe procedure with acceptable midterm results. Long term follow-up with increased sample power is mandatory in order to access hemodynamic, life quality and survival (Source: Revista Brasileira de Cirurgia Cardiovascular)

Impact of Chronic Kidney Disease on the Presence and Severity of Aortic Stenosis in Patients at High Risk for Coronary Artery Disease

Cardiovascular Ultrasound — Wed, 16 Nov 2011 05:00:00 +0100

Conclusion: CKD, even pre-stage 5 CKD, has a more powerful impact on the presence and severity of AS than other conventional risk factors for atherosclerosis in patients at high risk for CAD. (Source: Cardiovascular Ultrasound)

Assessment of Valvular Calcification and Inflammation by Positron Emission Tomography in Patients with Aortic Stenosis.

Circulation — Wed, 16 Nov 2011 05:00:00 +0100

CONCLUSIONS: -Positron emission tomography is a novel, feasible and repeatable approach to thee valuation of valvular calcification and inflammation in patients with aortic stenosis. The frequency and magnitude of increased tracer activity correlates with disease severity, and is strongest for 18F-NaF. Clinical Trial Registration Information-ClinicalTrials.gov; Reference Number: NCT01358513. PMID: 22090163 [PubMed - as supplied by publisher] (Source: Circulation)

Impact of aortic stiffness on left ventricular function and B-type natriuretic peptide release in severe aortic stenosis

European Journal of Echocardiography — Tue, 15 Nov 2011 05:00:00 +0100

Conclusions In patients with severe AS and preserved LV ejection fraction, independently of the valvular load, an increase in aortic rigidity, as assessed by aortic beta index, is independently correlated with reduced LV longitudinal function, increased LV filling pressures, and BNP levels. (Source: European Journal of Echocardiography)

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New Analysis Measures Cost Effectiveness Of Transcatheter Aortic Valve Replacement Compared To Surgical Valve Replacement

Health News from Medical News Today — Mon, 14 Nov 2011 08:00:00 +0100

The cost effectiveness of transcatheter aortic valve implantation (TAVR) compared to surgical aortic valve replacement (SAVR) depends on whether TAVR is performed via the femoral artery or transapically, through a small incision in the chest, according to a new study. Recently, transcatheter aortic valve implantation (TAVR) has been shown to result in similar 12-month survival as surgical aortic valve replacement (SAVR) for high-risk patients with severe aortic stenosis... (Source: Health News from Medical News Today)

Quality Of Life Benefits Of Transcatheter Aortic Valve Replacement Differ By Access Site

Health News from Medical News Today — Mon, 14 Nov 2011 08:00:00 +0100

Results of the PARTNER Cohort A QOL study demonstrate that transcatheter aortic valve replacement (TAVR) results in improved quality of life compared with surgical valve replacement, but only when performed via the transfemoral approach. The results of the study were presented at the 23rd annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium, sponsored by the Cardiovascular Research Foundation. Over the past decade, TAVR has been developed as a less invasive alternative to surgical valve replacement (AVR) for high-risk patients with severe aortic stenosis... (Source: Health News from Medical News Today)

PARTNER Trial Cohort B 2-Year Follow Up Results Presented At TCT 2011

Health News from Medical News Today — Mon, 14 Nov 2011 08:00:00 +0100

A two-year study of patients in the landmark PARTNER trial, which compared transcatheter aortic valve replacement (TAVR) in patients who have severe aortic stenosis and are not candidates for open heart surgery, confirm the one-year findings and support the role of TAVR as the standard of care. Trial results were presented at the 23rd annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium, sponsored by the Cardiovascular Research Foundation... (Source: Health News from Medical News Today)

Influence of left ventricular geometry and function on aortic annular dimensions as assessed with multi-detector row computed tomography: implications for transcatheter aortic valve implantation

European Heart Journal — Mon, 14 Nov 2011 05:00:00 +0100

Conclusion In severe AS patients, the presence of LV dysfunction, not the presence of severe AS, was an independent determinant of a larger aortic annular diameter. (Source: European Heart Journal)

Accuracy of Two-Dimensional Echocardiography in Determining Aortic Valve Structure in Patients >50 Years of Age Having Aortic Valve Replacement for Aortic Stenosis

The American Journal of Cardiology — Sun, 13 Nov 2011 02:35:42 +0100

In conclusion, aortic valve structure was interpretable by transthoracic echocardiogram in 86 of 100 patients and accurate in 57 of these 86 patients (66%). (Source: The American Journal of Cardiology)

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Transcatheter Valve-in-Valve Implantation for Failed Surgical Bioprosthetic Valves

Journal of the American College of Cardiology — Sun, 13 Nov 2011 02:25:40 +0100

When bioprosthetic cardiac valves fail, reoperative valve replacement carries a higher risk of morbidity and mortality compared with initial valve replacement. Transcatheter heart valve implantation may be a viable alternative to surgical aortic valve replacement for high-risk patients with native aortic stenosis, and valve-in-valve (V-in-V) implantation has been successfully performed for failed surgical bioprostheses in the aortic, mitral, pulmonic, and tricuspid positions. Despite some core similarities to transcatheter therapy of native valve disease, V-in-V therapy poses unique clinical and anatomic challenges. In this paper, we review the challenges, selection criteria, techniques, and outcomes of V-in-V implantation. (Source: Journal of the American College of Cardiology)

Stroke Associated With Surgical and Transcatheter Treatment of Aortic Stenosis: A Comprehensive Review

Journal of the American College of Cardiology — Sun, 13 Nov 2011 02:25:39 +0100

Stroke is a potential complication of treating patients with aortic stenosis via surgical aortic valve replacement (AVR), transcatheter aortic valve replacement (TAVR), and balloon aortic valvuloplasty. Because there are limited and heterogeneous data on the incidence, risk factors, and outcomes of stroke among patients being treated for aortic stenosis, we performed a comprehensive review of the literature. The risk of stroke after AVR in the general population is approximately 1.5%, and the risk is increased (to approximately 2% to 4%) in older and higher-risk patients. Strokes were reported in 1.5% to 6% of patients treated with TAVR, and in the only randomized trial of AVR versus TAVR, there was an increased risk of 30-day strokes (minor and major strokes and transient ischemic attacks...

Clinical Outcomes of Patients With Severe Aortic Stenosis at Increased Surgical Risk According to Treatment Modality

Journal of the American College of Cardiology — Sun, 13 Nov 2011 02:25:39 +0100

Objectives: The aim of this study was to assess the role of transcatheter aortic valve implantation (TAVI) compared with medical treatment (MT) and surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (AS) at increased surgical risk.Background: Elderly patients with comorbidities are at considerable risk for SAVR.Methods: Since July 2007, 442 patients with severe AS (age: 81.7 ± 6.0 years, mean logistic European System for Cardiac Operative Risk Evaluation: 22.3 ± 14.6%) underwent treatment allocation to MT (n = 78), SAVR (n = 107), or TAVI (n = 257) on the basis of a comprehensive evaluation protocol as part of a prospective registry.Results: Baseline clinical characteristics were similar among patients allocated to MT and TAVI, whereas patients allocated to ...

Are You Too Young?⁎

Journal of the American College of Cardiology — Sun, 13 Nov 2011 02:25:39 +0100

At a time when the value of performing aortic valve replacement surgery on elderly patients with aortic stenosis (AS) was being questioned, we reported our findings of a formal decision analysis entitled “You're Never Too Old” () that revealed survival benefit of surgical aortic valve replacement (SAVR) in symptomatic elderly AS patients. SAVR is currently widely accepted as a treatment of otherwise healthy patients in the upper decades of life who are suffering from severe symptomatic AS. In such patients SAVR improves survival, symptoms, and quality of life associated with this disease (). With an increasingly aging population, aortic valve replacement is now the most common reason for valve replacement in Europe and North America. However, approximately one-third of otherwise eligib...

Transfemoral, But Not Transapical TAVR, 'Economically Attractive'Transfemoral, But Not Transapical TAVR, 'Economically Attractive'

Medscape Today Headlines — Fri, 11 Nov 2011 18:26:27 +0100

An economic analysis of patients with severe aortic stenosis and high surgical risk reveals that transcatheter aortic valve replacement via the femoral artery is an "economically attractive" option compared with aortic valve replacement surgery. Transapical TAVR, on the other hand, does not share the same financial upside, say researchers. Heartwire (Source: Medscape Today Headlines)

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Transfemoral, but not transapical TAVR, "economically attractive"

theHeart.org — Fri, 11 Nov 2011 01:20:00 +0100

An economic analysis of patients with severe aortic stenosis and high surgical risk reveals that transcatheter aortic-valve replacement via the femoral artery is an "economically attractive" option compared with aortic-valve replacement surgery. Transapical TAVR, on the other hand, does not share the same financial upside, say researchers. (Source: theHeart.org)

A case of severe aortic stenosis with severe coronary artery disease that was successfully treated by balloon aortic valvuloplasty and percutaneous coronary intervention

Heart and Vessels — Thu, 10 Nov 2011 16:51:25 +0100

We describe an 85-year-old woman with severe aortic stenosis, who also had severe coronary artery disease. She suffered from dyspnea on exertion and frequent syncope. Echocardiography revealed an immobile and heavily calcified aortic valve, and coronary angiography revealed two-vessel disease including chronic total occlusion. Open-heart surgery was refused and she was referred to our department. She underwent percutaneous coronary intervention (PCI) for the right coronary artery and left anterior descending artery. Following PCI, percutaneous balloon aortic valvuloplasty (BAV) was performed on the same day. We chose balloons of 15 × 60 mm, 18 × 60 mm, and 20 × 60 mm, respectively. Improvement in the mean aortic valve pressure gradient (PG) and calculated aortic valve area (mean P...

Results of the PARTNER Trial Cohort B 2-year follow up presented at TCT 2011

EurekAlert! - Medicine and Health — Thu, 10 Nov 2011 05:00:00 +0100

(Cardiovascular Research Foundation) A two-year study of patients in the landmark PARTNER trial, which compared transcatheter aortic valve replacement (TAVR) in patients who have severe aortic stenosis and are not candidates for open heart surgery, confirm the one-year findings and support the role of TAVR as the standard of care. Trial results were presented today at the 23rd annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium, sponsored by the Cardiovascular Research Foundation. (Source: EurekAlert! - Medicine and Health)

Mitral Regurgitation in Patients Referred for Transcatheter Aortic Valve Implantation Using the Edwards Sapien Prosthesis: Mechanisms and Early Postprocedural Changes

Journal of the American Society of Echocardiography — Thu, 10 Nov 2011 05:00:00 +0100

Conclusions: In patients referred for TAVI, MR is common, mainly organic, and rarely severe. After TAVI, MR improved within 7 days in both organic and functional MR, was not influenced by overlap of the anterior mitral leaflet and the device, but was associated with improvement in LV ejection fraction. Possible MR improvement should be taken into account in patient selection for TAVI especially, in cases of LV dysfunction or enlargement and MR of borderline severity. (Source: Journal of the American Society of Echocardiography)

Comparison of Ascending Aortic Size in Patients With Severe Bicuspid Aortic Valve Stenosis Treated With Versus Without a Statin Drug

The American Journal of Cardiology — Thu, 10 Nov 2011 00:17:56 +0100

Ascending aortic dilation commonly occurs in patients with bicuspid aortic valve (BAV). Statins have been shown to reduce the expression of matrix metalloproteinases and slow the progression of abdominal aortic aneurysms. The role of statins in slowing ascending aortic dilation in patients with BAV is unknown. We sought to compare the ascending aortic dimensions in patients with BAV stenosis treated with versus without a statin. From our catheterization laboratory database, all patients undergoing preoperative coronary angiography before aortic valve with or without ascending aorta replacement for bicuspid aortic stenosis (AS) from 2004 to 2007 were identified. The ascending aortic size was measured on their preoperative transesophageal echocardiogram. Data on statin use were obtained from...

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Dietary fish oil preserves cardiac function in the hypertrophied rat heart.

The British Journal of Nutrition — Wed, 09 Nov 2011 05:00:00 +0100

Authors: McLennan PL, Abeywardena MY, Dallimore JA, Raederstorff D Abstract Regular fish or fish oil intake is associated with a low incidence of heart failure clinically, and fish oil-induced reduction in cardiac remodelling seen in hypertrophy models may contribute. We investigated whether improved cardiac energy efficiency in non-hypertrophied hearts translates into attenuation of cardiac dysfunction in hypertrophied hearts. Male Wistar rats (n 33) at 8 weeks of age were sham-operated or subjected to abdominal aortic stenosis to produce pressure-overload cardiac hypertrophy. Starting 3 weeks post-operatively to follow initiation of hypertrophy, rats were fed a diet containing 10 % olive oil (control) or 5 % fish oil (ROPUFA® 30 (17 % EPA, 10 % DHA))+5 % olive oil (FO diet)...

Persistent Left Superior Vena Cava With Retrograde Drainage From the Left Atrium Into the Left Brachiocephalic Vein

Journal of the American College of Cardiology — Tue, 08 Nov 2011 05:00:00 +0100

A 61-year-old female with no cardiac history presented with progressive right heart failure. Severe aortic stenosis, moderate mitral stenosis, and a markedly dilated right ventricle were found on transthoracic echocardiography and confirmed by cardiovascular magnetic resonance (CMR) imaging (A, Online Video 1). Phase-contrast imaging revealed a left-to-right shunt ratio of 2.4. Contrast-enhanced 3-dimensional MR angiography demonstrated an anomalous vein in the left hemithorax connecting the left brachiocephalic vein to the left atrium (B and C, Online Video 2). Time-resolved MR angiography (Online Video 3) and phase-contrast imaging (D) showed blood in this anomalous vein to flow cranially. Flow in this rare type of left superior vena cava is usually cranial-to-caudal and is associated wi...

Medtronic's Unmatched Portfolio of Cardiovascular Devices Features Prominently on Program for TCT 2011

News from Angioplasty.Org — Mon, 07 Nov 2011 22:30:00 +0100

Medtronic announces its week-long schedule of sessions and presentations at TCT 2011 that involve Medtronic devices, including stents and balloons for both coronary and peripheral artery disease, transcatheter valve for aortic stenosis, stent grafts for aortic aneurysms, and renal denervation for treatment-resistant hypertension and heart failure. (Source: News from Angioplasty.Org)

Real-World TAVI Results Mirror Clinical Trials (CME/CE)

MedPage Today State Required CME — Mon, 07 Nov 2011 20:13:24 +0100

(MedPage Today) -- In a real-world group of older patients with severe aortic stenosis, surgical valve replacement and transcatheter aortic valve implantation (TAVI) both improved clinical outcomes and symptoms compared with medical therapy, researchers found. (Source: MedPage Today State Required CME)

FDA approves Edwards transcatheter aortic heart valve

Hospital Management — Mon, 07 Nov 2011 09:00:00 +0100

The US Food and Drug Administration (FDA) has cleared Edwards Lifesciences' Sapien transcatheter aortic heart valve, designed to treat inoperable patients with severe symptomatic aortic stenosis. (Source: Hospital Management)

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Progressive induction of left ventricular pressure overload in a large animal model elicits myocardial remodeling and a unique matrix signature

The Journal of Thoracic and Cardiovascular Surgery — Mon, 07 Nov 2011 05:00:00 +0100

Conclusions: In a progressive model of left ventricular pressure overload, which recapitulates the phenotype of aortic stenosis, increased extracellular matrix accumulation and subsequently increased myocardial stiffness were not due to increased fibrillar collagen expression but rather to determinants of post-translational control that included increased collagen stability (thereby resistant to matrix metalloproteinase degradation) and increased endogenous matrix metalloproteinase inhibition. Targeting these extracellular matrix post-translational events with left ventricular pressure overload may hold both diagnostic and therapeutic relevance. (Source: The Journal of Thoracic and Cardiovascular Surgery)

Valvuloplasties can help elderly patients suffering from aortic stenosis

Telegraph Health — Fri, 04 Nov 2011 16:50:06 +0100

A simple procedure for widening the aortic valve is being increasingly used to help elderly patients, writes James Le Fanu. (Source: Telegraph Health)

New valve lets some patients take heart

Health Facts and Fears — Fri, 04 Nov 2011 04:00:00 +0100

Patients who are diagnosed with aortic stenosis, a narrowing and stiffening of the aortic valve in the heart, have for years faced a dire prognosis: either undergo risky open heart surgery, or face a two-year mortality rate of over 50 percent. But now a new artificial heart valve that can be inserted without any major surgery may allow old or frail patients to obtain the life-extending benefits of valve replacement without the risk of extensive surgery. (Source: Health Facts and Fears)

Arterial hypertension in degenerative non-severe aortic stenosis

Central European Journal of Medicine — Thu, 03 Nov 2011 16:53:55 +0100

Conclusions The non-severe degenerative AS-population had higher 10 years risk of cardiovascular death based on SCORE system than severe AS-patients, what was probably resulted from arterial hypertension. Content Type Journal ArticleCategory Research ArticlePages 1-5DOI 10.2478/s11536-011-0114-1Authors Bogdan Jegier, Department of Cardiac Surgery, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, 91-425 Lodz, PolandRyszard Jaszewski, Department of Cardiac Surgery, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, 91-425 Lodz, PolandMalgorzata Lelonek, Department of Cardiology, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, 91-425 Lodz, Poland Journal Central European Journal of MedicineOnline ISSN 164...

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An Accessory Mitral Valve Leaflet Causing Left Ventricular Outflow Tract Obstruction and Associated with Severe Aortic Incompetence

Echocardiography — Wed, 02 Nov 2011 04:00:00 +0100

This case report describes a 20‐year‐old woman with Turner's syndrome who presented with reduced effort tolerance limited by dyspnea. She had previously been on pediatric cardiology follow‐up for congenital subvalvular aortic stenosis first diagnosed at age 7. Unfortunately she defaulted after two visits before any intervention could be done. Transthoracic echocardiography demonstrated severe aortic incompetence (AI) with a membrane‐like structure in the left ventricular outflow tract (LVOT). The mean pressure gradient across the LVOT on continuous wave Doppler was 41 mmHg. The membranous interventricular septum appeared aneurysmal and it was observed that the “subaortic membrane” had a connection to the anterolateral papillary muscle via a strand of chordal tissue. Further ima...

Transcatheter Self-Expandable Aortic Valve Implantation After Undersized Mitral Annuloplasty [CASE REPORTS]

The Annals of Thoracic Surgery — Tue, 01 Nov 2011 04:00:00 +0100

We report our experience with percutaneous aortic self-expandable valve implantation in a 76-year-old woman affected by severe aortic stenosis, previously operated on for "undersized" mitral annuloplasty repair of severe functional mitral regurgitation in dilated cardiomyopathy. No deformation of the nitinol tubing of the CoreValve device (CoreValve, Inc, Irvine, CA), neither distortion nor malfunction nor change of the conformation of the mitral ring occurred. No change in mitral function and regurgitation was evident at echocardiography monitoring, which was performed during the implant. (Source: The Annals of Thoracic Surgery)

Compression of an Anomalous Left Circumflex Artery After Aortic and Mitral Valve Replacement [CASE REPORTS]

The Annals of Thoracic Surgery — Tue, 01 Nov 2011 04:00:00 +0100

A 52-year-old gentleman with a history of rheumatic fever presented with dyspnea. Transthoracic echocardiography revealed severe valvular aortic stenosis and severe mitral stenosis. A preoperative coronary angiogram revealed an anomalous left circumflex (LCX) artery arising from the right coronary sinus. The patient underwent aortic and mitral valve replacement. Postoperatively, a non-ST segment elevation myocardial infarction developed, and coronary angiography confirmed subtotal occlusion of the anomalous LCX. An emergent reoperation with surgical revascularization was performed. Intraoperatively, the mechanism of injury to the LCX was determined to be compression of the distal LCX by the sewing ring of the two prosthetic valves. (Source: The Annals of Thoracic Surgery)

Are Transcatheter Aortic Valve Implantations Cost-Effective in the Management of Patients With Aortic Stenosis? [CORRESPONDENCE]

The Annals of Thoracic Surgery — Tue, 01 Nov 2011 04:00:00 +0100

(Source: The Annals of Thoracic Surgery)

Are respiratory complications common causes of death in inflammatory myopathies? An autopsy study

Respirology — Tue, 01 Nov 2011 04:00:00 +0100

Conclusions We conclude that pulmonary injury is the immediate cause of death in one‐third of patients with PM/DM; acute exacerbation of chronic interstitial lung disease and bronchopneumonia were the most common specific causes. Immediate cause of death was not established antemortem in nearly one‐third of cases and some of these causes were treatable. (Source: Respirology)

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Double Duty For Blood Pressure Drugs: How They Could Revolutionize How We Treat Valve Disease

Health News from Medical News Today — Wed, 26 Oct 2011 07:00:00 +0100

A type of medication known as angiotensin-receptor blockers could reduce risk of mortality in people with a heart disease called calcific aortic stenosis (AS) by 30 per cent over an eight-year period, Heart and Stroke Foundation researcher Dr. Philippe Pibarot told delegates at the Canadian Cardiovascular Congress. The condition is currently managed with open heart surgery. "Our discovery shifts how we think about AS by looking at a new pathway which both prevents and reverses calcification," says Dr... (Source: Health News from Medical News Today)

Drug may treat one form of heart disease

Health News - UPI.com — Wed, 26 Oct 2011 04:59:19 +0100

VANCOUVER, British Columbia, Oct. 26 (UPI) -- A drug could replace surgery and reduce risk of mortality in people with the heart disease calcific aortic stenosis, Canadian researchers say. (Source: Health News - UPI.com)

Double duty for blood pressure drugs: how they could revolutionize how we treat valve disease

EurekAlert! - Medicine and Health — Tue, 25 Oct 2011 04:00:00 +0100

(Heart and Stroke Foundation of Canada) A type of medication known as angiotensin-receptor blockers could reduce risk of mortality in people with a heart disease called calcific aortic stenosis (AS) by 30 per cent over an eight-year period, Heart and Stroke Foundation researcher Dr. Philippe Pibarot told delegates at the Canadian Cardiovascular Congress. The condition is currently managed with open heart surgery. (Source: EurekAlert! - Medicine and Health)

The role of routine pre‐operative bedside echocardiography in detecting aortic stenosis in patients with a hip fracture*

Anaesthesia — Mon, 24 Oct 2011 04:00:00 +0100

SummaryThe prevalence and severity of aortic stenosis in unselected patients admitted with a hip fracture is unknown. Derriford Hospital operates a routine weekday, pre‐operative, targeted bedside echocardiography examination on all patients admitted with a hip fracture. We carried out a prospective service evaluation for 13 months from October 2007 on all 501 admissions, of which 374 (75%) underwent pre‐operative echocardiography. Of those patients investigated, 8 (2%) had severe, 24 (6%) moderate and 113 (30%) had mild aortic stenosis or aortic sclerosis. Eighty‐seven of 278 (31%) patients with no murmur detected clinically on admission had aortic stenosis on echocardiography and of the 96 patients in whom a murmur was heard pre‐operatively, 30 (31%) had a normal echocardiogram...

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Long-Term Outcomes After Transcatheter Aortic Valve Implantation in High-Risk Patients With Severe Aortic Stenosis: The U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry

Journal of the American College of Cardiology — Mon, 24 Oct 2011 04:00:00 +0100

The objective was to define the characteristics of a real-world patient population treated with transcatheter aortic valve implantation (TAVI), regardless of technology or access route, and to evaluate their clinical outcome over the mid to long term.Background: Although a substantial body of data exists in relation to early clinical outcomes after TAVI, there are few data on outcomes beyond 1 year in any notable number of patients.Methods: The U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry was established to report outcomes of all TAVI procedures performed within the United Kingdom. Data were collected prospectively on 870 patients undergoing 877 TAVI procedures up until December 31, 2009. Mortality tracking was achieved in 100% of patients with mortality stat...

Transcatheter Aortic Valve Implantation: A Snapshot From the United Kingdom⁎

Journal of the American College of Cardiology — Mon, 24 Oct 2011 04:00:00 +0100

Transcatheter aortic valve implantation (TAVI) is now increasingly performed, and >30,000 patients with severe aortic stenosis and contraindications to or high risk for surgery have been treated so far. The technique is still in its infancy, but evidence has rapidly accumulated through observational studies (), device-specific registries () or national registries (), and randomized clinical trials (). (Source: Journal of the American College of Cardiology)

Presence of a Congenitally Bicuspid Aortic Valve Among Patients Having Combined Mitral and Aortic Valve Replacement

The American Journal of Cardiology — Mon, 24 Oct 2011 04:00:00 +0100

In conclusion, various types of mitral dysfunction severe enough to warrant mitral valve replacement occur in patients with bicuspid aortic valves. A proper search for mitral valve dysfunction in patients with bicuspid aortic valves appears warranted. (Source: The American Journal of Cardiology)

BMI affects survival in patients undergoing aortic valve replacement

MedWire News - Cardiology — Sat, 22 Oct 2011 01:40:10 +0100

Results of a US study suggest that body mass index has a significant effect on survival in patients undergoing aortic valve replacement for aortic stenosis. (Source: MedWire News - Cardiology)

Transesophageal echocardiographic scoring for transcatheter aortic valve implantation: Impact of aortic cusp calcification on postoperative aortic regurgitation

The Journal of Thoracic and Cardiovascular Surgery — Thu, 20 Oct 2011 23:17:36 +0100

Conclusions: Transesophageal echocardiography demonstrates detailed anatomic information of the calcification patterns of the aortic valve and root and thus plays an important role in the screening of patients undergoing transcatheter aortic valve implantation. The transcatheter aortic valve implantation echocardiographic calcification score allowed prediction of the risk of postoperative paravalvular and overall aortic regurgitation. (Source: The Journal of Thoracic and Cardiovascular Surgery)

Aortic valve replacement for aortic stenosis in patients with concomitant mitral regurgitation: should the mitral valve be dealt with? [Review]

European Journal of Cardio-Thoracic Surgery — Thu, 20 Oct 2011 04:00:00 +0100

Co-existent mitral regurgitation may adversely influence both morbidity and mortality in patients undergoing aortic valve replacement for severe aortic stenosis. Whilst it is accepted that concomitant mitral intervention is required in severe, symptomatic mitral regurgitation, in cases of mild–moderate non-structural mitral regurgitation, improvement may be seen following aortic valve replacement alone, avoiding the increased risk of double-valve surgery. The exact benefit of such a conservative approach is, however, yet to be adequately quantified. We performed a systematic literature review identifying 17 studies incorporating 3053 patients undergoing aortic valve replacement for aortic stenosis with co-existing mitral regurgitation. These were meta-analysed using random effects mo...

Trans-catheter valve-in-valve implantation: in vitro hydrodynamic performance of the SAPIEN + cloth trans-catheter heart valve in the Carpentier-Edwards Perimount valves [Original articles]

European Journal of Cardio-Thoracic Surgery — Thu, 20 Oct 2011 04:00:00 +0100

Conclusions: Compared with the rigorous ISO 5840:2500 valve standards, the Edwards SAPIEN + cloth THV implanted ViV within the CEP valve demonstrated excellent hydrodynamic performance. (Source: European Journal of Cardio-Thoracic Surgery)

TAVI Outcomes 'Encouraging' Once a Year Is Past (CME/CE)

MedPage Today Cardiovascular — Wed, 19 Oct 2011 20:52:54 +0100

(MedPage Today) -- Although about one patient in five undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis died within the first year, survival was good after that, a British study showed. (Source: MedPage Today Cardiovascular)

Management of Patients With Bicuspid Aortic Valve Disease

Current Treatment Options in Cardiovascular Medicine — Wed, 19 Oct 2011 05:52:28 +0100

Opinion statement Our approach to the management of the patient with a bicuspid aortic valve (BAV) takes several factors into consideration. First, is the dysfunction of the valve due to aortic stenosis (AS), aortic regurgitation (AR), or a combination of stenosis and regurgitation, and what is the severity? Next, is there aortic dilation in any of the regions (sinuses of Valsalva, sinotubular junction, tubular ascending aorta, or transverse arch) discussed in this article. In general, we follow patients with a BAV and moderate valve dysfunction (AS or AR) with yearly surveillance transthoracic echocardiography for left ventricular function, jet velocity, gradient, and valve area with AS, whereas left ventricular (LV) function and LV dimensions are monitored for patients w...

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Measurement of the ascending aorta diameter in patients with severe bicuspid and tricuspid aortic valve stenosis using dual-source computed tomography coronary angiography

The International Journal of Cardiovascular Imaging — Tue, 18 Oct 2011 15:59:17 +0100

Abstract We aimed to evaluate the diagnostic performance of dual-source computed tomography coronary angiography (DSCT-CA) in the measurement of the ascending aorta (AA) diameter and compare the AA diameter in patients with severe bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) stenosis. Eighty-eight consecutive patients (50 men, mean age 60.3 ± 13 year) with severe aortic stenosis (AS) underwent DSCT-CA before aortic valve surgery. Seventy-four of the 88 patients underwent cardiovascular magnetic resonance (CMR). The internal diameter of AA was measured from early-systole with DSCT-CA and CMR by 2 radiologists independently at 4 levels (aortic annulus, sinuses of Valsalva, sinotubular junction, and tubular portion at the right pulmonary artery)...

Calcific aortic valve disease: not simply a degenerative process: a review and agenda for research from the national heart and lung and blood institute aortic stenosis working group * executive summary: calcific aortic valve disease - 2011 update.

Circulation — Tue, 18 Oct 2011 04:00:00 +0100

Authors: Rajamannan NM, Evans FJ, Aikawa E, Grande-Allen KJ, Demer LL, Heistad DD, Simmons CA, Masters KS, Mathieu P, O'Brien KD, Schoen FJ, Towler DA, Yoganathan AP, Otto CM PMID: 22007101 [PubMed - in process] (Source: Circulation)

Effects of Aortic Valve Replacement on Left Ventricular Dyssynchrony in Aortic Stenosis with Narrow QRS Complex

Journal of the American Society of Echocardiography — Mon, 17 Oct 2011 04:00:00 +0100

Conclusions: LV dyssynchrony is not uncommon in patients with AS with narrow QRS complexes and is reversible early after AVR, suggesting the favorable effect of afterload reduction on dyssynchronous LV contraction. (Source: Journal of the American Society of Echocardiography)

Angiotensin receptor blockers are associated with a lower remodelling score of stenotic aortic valves

European Journal of Clinical Investigation — Sun, 16 Oct 2011 02:20:20 +0100

Conclusions ARBs were associated with lower aortic valve weight and less pronounced tissue remodelling. Further studies are needed to determine if ARBs could be used as a therapeutic avenue in AS. (Source: European Journal of Clinical Investigation)

Guidelines for the Diagnosis and Management of Hypertrophic Cardiomyopathy

Heart, Lung and Circulation — Sat, 15 Oct 2011 01:44:50 +0100

Hypertrophic cardiomyopathy (HCM) is a primary cardiac disorder characterised by hypertrophy, usually of the left ventricle, in the absence of other loading conditions, such as aortic stenosis, hypertension or thyroid disease. Although previously thought of as a rare disorder, recent population-based clinical studies suggest the prevalence of the condition to be as high as 0.2% (or 1 in 500) in the general population making HCM the commonest known cardiovascular genetically determined disorder known. (Source: Heart, Lung and Circulation)

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Effect of Body Mass Index on Survival in Patients Having Aortic Valve Replacement for Aortic Stenosis With or Without Concomitant Coronary Artery Bypass Grafting

The American Journal of Cardiology — Fri, 14 Oct 2011 04:00:00 +0100

In conclusion, the findings in this study indicate a strong and significant adjusted association between BMI and 30-day and long-term mortality in patients having AVR for AS with or without concomitant coronary artery bypass grafting. Better survival was observed in patients with BMIs in the low 30s compared to patients with BMIs in the mid 20s and >40 kg/m2. (Source: The American Journal of Cardiology)

The doubtful association between blood lipid changes and progression of coronary calcification

International Journal of Cardiology — Thu, 13 Oct 2011 04:00:00 +0100

We greatly appreciated the interesting and stimulating discussion letter by Ravnskov commenting on our recent study which concluded that both cholesterol changes over time and presence of lipid lowering therapy do not seem to have any measurable effect on the rate of progression of coronary calcification when assessed by computerized tomography (CT) . We believe that the process of calcification may spread out in a different manner than the overall development of atherosclerosis. It is interesting to point out a total failure of statins and/or ezetimibe based lipid lowering therapy to stop the progression of calcific aortic stenosis despite their clear clinical benefits in reducing atherosclerotic vascular events. (Source: International Journal of Cardiology)

Delayed migration of a transfemorally implanted aortic bioprosthesis

The Journal of Thoracic and Cardiovascular Surgery — Thu, 13 Oct 2011 04:00:00 +0100

We report the delayed migration of a transfemorally implanted aortic bioprosthesis and discuss the potential causes of this complication. (Source: The Journal of Thoracic and Cardiovascular Surgery)

Aortic stenosis and angiodysplastic gastrointestinal bleeding: Heyde’s disease

Heart and Lung — Thu, 13 Oct 2011 04:00:00 +0100

We present a 66-year-old man with a medical history of coronary artery disease who presented with acute GI bleeding. During his hospital course, the patient had a colonoscopy showing diffuse angiodysplasia and an echocardiogram showing severe aortic stenosis. This combination of angiodysplasia and aortic stenosis is known as Heyde’s syndrome. It has been hypothesized that the aortic stenosis causes an acquired von Willebrand factor deficiency that leads to GI bleeding. Aortic valve replacement, when possible, can prevent recurrent GI bleeding in these cases, but medical decisions in these cases are complex and difficult. (Source: Heart and Lung)

Left Ventricular Noncompaction/Hypertrabeculation: Distinctive Entity or Abnormality, Frequently Associated With Neuromuscular Disorders?

The American Journal of Cardiology — Wed, 12 Oct 2011 01:43:59 +0100

We read with interest the report by Roberts et al regarding 3 explanted hearts that fulfilled anatomically the echocardiographic definition of left ventricular noncompaction/hypertrabeculation (LVHT). Photographs of 18 cases were reviewed, but only 7 were assessed as representing clear examples of LVHT. It was assumed that LVHT is overdiagnosed in the other cases, at least morphologically. We have several concerns and questions: What is the specificity of the anatomic definition of noncompacted portion of left ventricular free walls ≥2 times as thick as the compacted portions of these walls? Magnetic resonance imaging shows that areas of noncompaction are common in healthy volunteers, athletes, patients with hypertrophic or dilated cardiomyopathy, and patients with aortic stenosis. Addit...

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Hemodynamic and Clinical Impact of Prosthesis–Patient Mismatch After Transcatheter Aortic Valve Implantation

Journal of the American College of Cardiology — Mon, 10 Oct 2011 04:00:00 +0100

Conclusions: PPM may be observed after TAVI and when present may be accompanied by less favorable changes in transvalvular hemodynamics, limited LV mass regression, persistent elevated LV filling pressure, and less improvement in clinical functional status. (Source: Journal of the American College of Cardiology)

Prosthesis–Patient Mismatch in the Transcatheter Aortic Valve Replacement Era⁎

Journal of the American College of Cardiology — Mon, 10 Oct 2011 04:00:00 +0100

In an insightful report in 1978, Rahimtoola () pointed to the fact that “mismatch can be considered to be present when the effective prosthetic valve area, after insertion into the patient, is less than that of a normal human valve.” He recognized that most patients have some residual aortic stenosis after aortic valve replacement and suggested that moderate or severe residual aortic stenosis may have clinical significance, although more work is needed to be done to better understand this phenomenon and identify its clinical implications. (Source: Journal of the American College of Cardiology)

Transfemorally or Transapically Deployed Sapien Edwards Bioprosthesis Is Always Deformed

Journal of Interventional Cardiology — Sun, 09 Oct 2011 04:00:00 +0100

Conclusion: Fluoroscopically assessed, the geometry of SE prosthesis was never cylindrical after deployment, whatever the access for implantation was. Longitudinal deformation was greater after TF ‐ TAVI whereas leaflet to stent mismatch tended to be more pronounced after TA ‐ TAVI. (J Interven Cardiol 2011;**:1 – 9) (Source: Journal of Interventional Cardiology)

Transcatheter Aortic Valve Implantation in Degenerate Failing Aortic Homograft Root Replacements

Journal of the American College of Cardiology — Sun, 09 Oct 2011 01:54:11 +0100

As with all bioprosthetic aortic valve substitutes, homografts are prone to late degeneration characterized by dense calcification and valve dysfunction. Reoperation in patients with prior homograft aortic root replacement may carry a substantial risk, particularly in elderly patients and patients with significant comorbidities. Even in relatively fit patients, it can be technically challenging, especially where there have been multiple previous procedures or when there is calcification around the coronary ostia. Transcatheter aortic valve implantation (TAVI) has become a recognized treatment for patients with severe aortic stenosis (AS) who are at high risk from conventional surgery. A small number of reports () have described the use of TAVI as a valve-in-valve procedure for structural d...